Update on conventional therapy for atopic dermatitis

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and requires therapy that is individualized, yet also based on the current guidelines. This narrative review gives an update on the conventional therapy of AD depending on severity according to the German S3 guideline on AD. AD severity is graded as mild, moderate, and severe AD. Consequent topical basic therapy and avoidance of potential trigger factor is recommended for all patients. Basic therapy should be applied not only during a flare, but also to clear skin to prevent worsening; furthermore, mild/moderate eczema should receive anti-inflammatory therapy with topical corticosteroids/calcineurin inhibitors. Systemic therapy is indicated in moderate-to-severe AD with insufficient response to other measures, if applicable, also ultraviolet therapy. Systemic therapies are grouped into conventional and targeted therapies (biologics and Janus kinase inhibitors). Systemic corticosteroids should only be used as rescue therapy for 3 weeks maximum. Targeted therapies in AD have the highest recommendation grade for long-term therapy. Cyclosporin A (CsA), azathioprine (AZT), methotrexate (MTX), and mycophenolate mofetil (MMF) belong to the conventional steroid-sparing therapies. However, only CsA is licensed for AD. MTX should be and MMF might be considered for AD according to the German S3 guideline, while AZT may be considered in adults.